Research progress on neoadjuvant, adjuvant, and perioperative comprehensive treatment strategies for resectable pancreatic ductal adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Lei ¹ , LIU Gang ¹ , GUO Zicheng ¹ , ZHAO Haichun ¹ , LUO Mengxin ² ,  HAN Hongbin ³

1. Department of General Surgery, Panjin Liao-Oil Gem Flower Hospital, Panjin, Liaoning 124010, P. R. China;
2. Department of Quality Management, Panjin Liao-Oil Gem Flower Hospital, Panjin, Liaoning 124010, P. R. China;
3. Department of Oncological Surgery, Panjin Liao-Oil Gem Flower Hospital, Panjin, Liaoning 124010, P. R. China;

Corresponding?author：

HAN Hongbin, Email: 309267507@qq.com

Keywords：

resectable pancreatic ductal adenocarcinoma; adjuvant therapy; neoadjuvant therapy; immunotherapy; overall survival; disease-free survival

DOI：

10.7507/1007-9424.202603070

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Objective To systematically review the evidence evolution of neoadjuvant, adjuvant, and perioperative comprehensive treatment strategies for resectable pancreatic ductal adenocarcinoma (PDAC), analyze the efficacy and limitations of different therapeutic modalities, and propose future directions to guide clinical practice. Methods A systematic review and analysis were conducted of pivotal randomized controlled trials and landmark studies regarding resectable PDAC published over the past three decades. Three core strategies, including adjuvant chemoradiotherapy, adjuvant chemotherapy, and combined neoadjuvant-adjuvant therapy, were focused on. The study designs, endpoints, and key conclusions of representative trials were subsequently summarized. Results Adjuvant chemoradiotherapy has been progressively marginalized, as no overall survival benefit has been confirmed and increased toxicities have been observed in most randomized controlled trials; its use is currently restricted to highly selected patients. In contrast, adjuvant chemotherapy has emerged as the cornerstone of care, with iterative refinements in regimens—from single-agent gemcitabine to gemcitabine plus capecitabine, S-1 monotherapy (for Asian populations), and mFOLFIRINOX (for appropriately selected patients)—resulting in significantly prolonged survival. Combined neoadjuvant-adjuvant therapy has emerged as a prominent focus, with multiple phase Ⅱ/Ⅲ trials demonstrating improved R0 resection rate, disease-free survival, and overall survival with multidrug regimens such as mFOLFIRINOX. However, these benefits are found to be highly dependent on chemotherapy intensity, patient tolerance, and surgical quality. Additionally, both immunochemotherapy and circulating tumor DNA-based minimal residual disease surveillance are under active investigation as promising therapeutic and monitoring strategies, respectively.Conclusions The perioperative management of resectable PDAC has undergone a paradigm shift—from adjuvant chemoradiotherapy to a systemic, chemotherapy-dominant approach—exemplified by mFOLFIRINOX. Adjuvant chemotherapy is firmly established as the cornerstone of care, reflecting iterative refinement of systemic therapies. While combined neoadjuvant-adjuvant therapy improves R0 resection rate and survival, it requires careful balancing of regimen intensity with patient tolerance. Future development will focus on individualized, whole-course management, integrating immunochemotherapy and circulating tumor DNA-based minimal residual disease surveillance.

Citation： ZHU Lei, LIU Gang, GUO Zicheng, ZHAO Haichun, LUO Mengxin, HAN Hongbin. Research progress on neoadjuvant, adjuvant, and perioperative comprehensive treatment strategies for resectable pancreatic ductal adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1135-1142. doi: 10.7507/1007-9424.202603070 Copy

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2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2024, 74(3): 229-263.
3.	Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
4.	Conroy T, Pfeiffer P, Vilgrain V, et al. Pancreatic cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up [J]. Ann Oncol, 2023, 34(11): 987-1002.
5.	Okusaka T, Nakamura M, Yoshida M, et al. Clinical practice guidelines for pancreatic cancer 2022 from the Japan Pancreas Society: a synopsis [J]. Int J Clin Oncol, 2023, 28(4): 493-511.
6.	Ciocan RA, Ciocan A, Zaharie FV, et al. Perioperative management of patients with pancreatic cancer—the ERAS protocols [J]. Chirurgia (Bucur), 2022, 117(4): 415-422.
7.	Aoyama T, Hara K, Saito A, et al. Adjuvant treatment for resectable pancreatic cancer [J]. Anticancer Res, 2025, 45(4): 1329-1341.
8.	Wan P, Zhou SQ, Ke QH. Very early recurrence after pancreatic cancer resection: unmasking the “biological R2” enigma and rethinking prognostic paradigms [J/OL]. World J Gastrointest Surg, 2025, 17(12): 114403. doi: 10.4240/wjgs.v17.i12.114403.
9.	Kalser MH, Ellenberg SS. Pancreatic cancer: adjuvant combined radiation and chemotherapy following curative resection [J]. Arch Surg, 1985, 120(8): 899-903.
10.	Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase Ⅲ trial of the EORTC gastrointestinal tract cancer cooperative group [J]. Ann Surg, 1999, 230(6): 776-782.
11.	Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer [J]. N Engl J Med, 2004, 350(12): 1200-1210.
12.	Van Laethem JL, Hammel P, Mornex F, et al. Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer: a randomized EORTC-40013-22012/FFCD-9203/GERCOR phase Ⅱ study [J]. J Clin Oncol, 2010, 28(29): 4450-4456.
13.	Schmidt J, Abel U, Debus J, et al. Open-label, multicenter, randomized phase Ⅲ trial of adjuvant chemoradiation plus interferon Alfa-2b versus fluorouracil and folinic acid for patients with resected pancreatic adenocarcinoma [J]. J Clin Oncol, 2012, 30(33): 4077-4083.
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17.	Takada T, Amano H, Yasuda H, et al. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase Ⅲ multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma [J]. Cancer, 2002, 95(8): 1685-1695.
18.	Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial [J]. JAMA, 2007, 297(3): 267-277.
19.	Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial [J]. JAMA, 2013, 310(14): 1473-1481.
20.	Ueno H, Kosuge T, Matsuyama Y, et al. A randomised phase Ⅲ trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer [J]. Br J Cancer, 2009, 101(6): 908-915.
21.	Neoptolemos JP, Moore MJ, Cox TF, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial [J]. JAMA, 2012, 308(2): 147-156.
22.	Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01) [J]. Lancet, 2016, 388(10041): 248-257.
23.	Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial [J]. Lancet, 2017, 389(10073): 1011-1024.
24.	Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer [J]. N Engl J Med, 2018, 379(25): 2395-2406.
25.	Sinn M, Bahra M, Liersch T, et al. CONKO-005: adjuvant chemotherapy with gemcitabine plus erlotinib versus gemcitabine alone in patients after R0 resection of pancreatic cancer: a multicenter randomized phase Ⅲ trial [J]. J Clin Oncol, 2017, 35(29): 3330-3337.
26.	Abrams RA, Winter KA, Safran H, et al. Results of the NRG Oncology/RTOG 0848 adjuvant chemotherapy question: erlotinib plus gemcitabine for resected cancer of the pancreatic head: a phase Ⅱ randomized clinical trial [J]. Am J Clin Oncol, 2020, 43(3): 173-179.
27.	Golan T, Hammel P, Reni M, et al. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer [J]. N Engl J Med, 2019, 381(4): 317-327.
28.	Strickler JH, Satake H, George TJ, et al. Sotorasib in KRAS p. G12C-mutated advanced pancreatic cancer [J]. N Engl J Med, 2023, 388(1): 33-43.
29.	Casadei R, Di Marco M, Ricci C, et al. Neoadjuvant chemoradiotherapy and surgery versus surgery alone in resectable pancreatic cancer: a single-center prospective, randomized, controlled trial which failed to achieve accrual targets [J]. J Gastrointest Surg, 2015, 19(10): 1802-1812.
30.	Golcher H, Brunner TB, Witzigmann H, et al. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: results of the first prospective randomized phase Ⅱ trial [J]. Strahlenther Onkol, 2015, 191(1): 7-16.
31.	Reni M, Balzano G, Zanon S, et al. Safety and efficacy of preoperative or postoperative chemotherapy for resectable pancreatic adenocarcinoma (PACT-15): a randomised, open-label, phase 2-3 trial [J]. Lancet Gastroenterol Hepatol, 2018, 3(6): 413-423.
32.	Versteijne E, Suker M, Groothuis K, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase Ⅲ PREOPANC trial [J]. J Clin Oncol, 2020, 38(16): 1763-1773.
33.	Seufferlein T, Uhl W, Kornmann M, et al. Perioperative or only adjuvant gemcitabine plus nab-paclitaxel for resectable pancreatic cancer (NEONAX)—a randomized phase Ⅱ trial of the AIO pancreatic cancer group [J]. Ann Oncol, 2023, 34(1): 91-100.
34.	Schwarz L, Bachet JB, Meurisse A, et al. Neoadjuvant FOLF(IRIN)OX chemotherapy for resectable pancreatic adenocarcinoma: a multicenter randomized noncomparative phase Ⅱ trial (PANACHE01 FRENCH08 PRODIGE48 study) [J]. J Clin Oncol, 2025, 43(17): 1984-1996.
35.	Labori KJ, Bratlie SO, Andersson B, et al. Neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer (NORPACT-1): a multicentre, randomised, phase 2 trial [J]. Lancet Gastroenterol Hepatol, 2024, 9(3): 205-217.
36.	Janssen QP, van Dam JL, van Bekkum ML, et al. Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial [J]. Lancet Oncol, 2025, 26(10): 1346-1356.
37.	Garajová I, Peroni M, Gelsomino F, et al. A simple overview of pancreatic cancer treatment for clinical oncologists [J]. Curr Oncol, 2023, 30(11): 9587-9601.
38.	Dekker EN, van Dam JL, Janssen QP, et al. Improved clinical staging system for localized pancreatic cancer using the ABC factors: a TAPS consortium study [J]. J Clin Oncol, 2024, 42(12): 1357-1367.
39.	Pinson J, Henriques J, Beaussire L, et al. New biomarkers to define a biological borderline situation for pancreatic adenocarcinoma: results of an ancillary study of the PANACHE01-PRODIGE48 trial [J]. Ann Surg, 2024, 280(5): 734-744.
40.	Stoop TF, Sugawara T, Oba A, et al. Adjuvant chemotherapy after resection of localized pancreatic adenocarcinoma following preoperative FOLFIRINOX [J]. JAMA Oncol, 2025, 11(3): 276-287.
41.	Reni M, Macchini M, Orsi G, et al. Preoperative mFOLFIRINOX versus PAXG for stage Ⅰ–Ⅲ resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2×2 factorial phase 3 trial [J]. Lancet, 2026, 406(10522): 2945-2956.
42.	Wainberg ZA, Link JM, Premji A, et al. Neoadjuvant modified FOLFIRINOX plus nivolumab in borderline-resectable pancreatic ductal adenocarcinoma: a pilot phase 1 trial [J/OL]. Nat Commun, 2026, 17: 2232. doi: 10.1038/s41467-026-68976-2.
43.	Katz MHG, Petroni GR, Bauer T, et al. Multicenter randomized controlled trial of neoadjuvant chemoradiotherapy alone or in combination with pembrolizumab in patients with resectable or borderline resectable pancreatic adenocarcinoma [J/OL]. J Immunother Cancer, 2023, 11: e007586. doi: 10.1136/jitc-2023-007586.
44.	Agarwal P, Guo M, Munjal K, et al. A phase Ⅱ study of neoadjuvant GVAX and cyclophosphamide combined with nivolumab and SBRT followed by surgery in borderline resectable pancreatic adenocarcinoma [J]. Clin Cancer Res, 2025, 31(15): 3205-3214.
45.	Zheng L, Minasyan A, Davelaar J, et al. Preliminary translational immune and stromal correlates in a randomized phase Ⅱ trial of pembrolizumab with or without defactinib for resectable pancreatic ductal adenocarcinoma (PDAC) [J/OL]. J Clin Oncol, 2023, 41(16_suppl): 4024. doi: 10.1200/JCO.2023.41.16_suppl.4024.
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1. Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025 [J]. CA Cancer J Clin, 2025, 75(1): 10-45.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2024, 74(3): 229-263.
3. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
4. Conroy T, Pfeiffer P, Vilgrain V, et al. Pancreatic cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up [J]. Ann Oncol, 2023, 34(11): 987-1002.
5. Okusaka T, Nakamura M, Yoshida M, et al. Clinical practice guidelines for pancreatic cancer 2022 from the Japan Pancreas Society: a synopsis [J]. Int J Clin Oncol, 2023, 28(4): 493-511.
6. Ciocan RA, Ciocan A, Zaharie FV, et al. Perioperative management of patients with pancreatic cancer—the ERAS protocols [J]. Chirurgia (Bucur), 2022, 117(4): 415-422.
7. Aoyama T, Hara K, Saito A, et al. Adjuvant treatment for resectable pancreatic cancer [J]. Anticancer Res, 2025, 45(4): 1329-1341.
8. Wan P, Zhou SQ, Ke QH. Very early recurrence after pancreatic cancer resection: unmasking the “biological R2” enigma and rethinking prognostic paradigms [J/OL]. World J Gastrointest Surg, 2025, 17(12): 114403. doi: 10.4240/wjgs.v17.i12.114403.
9. Kalser MH, Ellenberg SS. Pancreatic cancer: adjuvant combined radiation and chemotherapy following curative resection [J]. Arch Surg, 1985, 120(8): 899-903.
10. Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase Ⅲ trial of the EORTC gastrointestinal tract cancer cooperative group [J]. Ann Surg, 1999, 230(6): 776-782.
11. Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer [J]. N Engl J Med, 2004, 350(12): 1200-1210.
12. Van Laethem JL, Hammel P, Mornex F, et al. Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer: a randomized EORTC-40013-22012/FFCD-9203/GERCOR phase Ⅱ study [J]. J Clin Oncol, 2010, 28(29): 4450-4456.
13. Schmidt J, Abel U, Debus J, et al. Open-label, multicenter, randomized phase Ⅲ trial of adjuvant chemoradiation plus interferon Alfa-2b versus fluorouracil and folinic acid for patients with resected pancreatic adenocarcinoma [J]. J Clin Oncol, 2012, 30(33): 4077-4083.
14. Tai D, Conroy T, Lee JJX, et al. Pan-Asian adapted ESMO clinical practice guidelines for the diagnosis, treatment and follow-up of patients with pancreatic cancer [J/OL]. ESMO Open, 2025, 10(10): 105826. doi: 10.1016/j.esmoop.2025.105826.
15. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma (version 1.2025) [EB/OL]. (2025-07-03). https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed July 3, 2025.
16. Sohal DPS, Walsh RM, Ramanathan RK, et al. Pancreatic adenocarcinoma: treating a systemic disease with systemic therapy [J/OL]. J Natl Cancer Inst, 2014, 106(3): dju011. doi: 10.1093/jnci/dju011.
17. Takada T, Amano H, Yasuda H, et al. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase Ⅲ multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma [J]. Cancer, 2002, 95(8): 1685-1695.
18. Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial [J]. JAMA, 2007, 297(3): 267-277.
19. Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial [J]. JAMA, 2013, 310(14): 1473-1481.
20. Ueno H, Kosuge T, Matsuyama Y, et al. A randomised phase Ⅲ trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer [J]. Br J Cancer, 2009, 101(6): 908-915.
21. Neoptolemos JP, Moore MJ, Cox TF, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial [J]. JAMA, 2012, 308(2): 147-156.
22. Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01) [J]. Lancet, 2016, 388(10041): 248-257.
23. Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial [J]. Lancet, 2017, 389(10073): 1011-1024.
24. Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer [J]. N Engl J Med, 2018, 379(25): 2395-2406.
25. Sinn M, Bahra M, Liersch T, et al. CONKO-005: adjuvant chemotherapy with gemcitabine plus erlotinib versus gemcitabine alone in patients after R0 resection of pancreatic cancer: a multicenter randomized phase Ⅲ trial [J]. J Clin Oncol, 2017, 35(29): 3330-3337.
26. Abrams RA, Winter KA, Safran H, et al. Results of the NRG Oncology/RTOG 0848 adjuvant chemotherapy question: erlotinib plus gemcitabine for resected cancer of the pancreatic head: a phase Ⅱ randomized clinical trial [J]. Am J Clin Oncol, 2020, 43(3): 173-179.
27. Golan T, Hammel P, Reni M, et al. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer [J]. N Engl J Med, 2019, 381(4): 317-327.
28. Strickler JH, Satake H, George TJ, et al. Sotorasib in KRAS p. G12C-mutated advanced pancreatic cancer [J]. N Engl J Med, 2023, 388(1): 33-43.
29. Casadei R, Di Marco M, Ricci C, et al. Neoadjuvant chemoradiotherapy and surgery versus surgery alone in resectable pancreatic cancer: a single-center prospective, randomized, controlled trial which failed to achieve accrual targets [J]. J Gastrointest Surg, 2015, 19(10): 1802-1812.
30. Golcher H, Brunner TB, Witzigmann H, et al. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: results of the first prospective randomized phase Ⅱ trial [J]. Strahlenther Onkol, 2015, 191(1): 7-16.
31. Reni M, Balzano G, Zanon S, et al. Safety and efficacy of preoperative or postoperative chemotherapy for resectable pancreatic adenocarcinoma (PACT-15): a randomised, open-label, phase 2-3 trial [J]. Lancet Gastroenterol Hepatol, 2018, 3(6): 413-423.
32. Versteijne E, Suker M, Groothuis K, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase Ⅲ PREOPANC trial [J]. J Clin Oncol, 2020, 38(16): 1763-1773.
33. Seufferlein T, Uhl W, Kornmann M, et al. Perioperative or only adjuvant gemcitabine plus nab-paclitaxel for resectable pancreatic cancer (NEONAX)—a randomized phase Ⅱ trial of the AIO pancreatic cancer group [J]. Ann Oncol, 2023, 34(1): 91-100.
34. Schwarz L, Bachet JB, Meurisse A, et al. Neoadjuvant FOLF(IRIN)OX chemotherapy for resectable pancreatic adenocarcinoma: a multicenter randomized noncomparative phase Ⅱ trial (PANACHE01 FRENCH08 PRODIGE48 study) [J]. J Clin Oncol, 2025, 43(17): 1984-1996.
35. Labori KJ, Bratlie SO, Andersson B, et al. Neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer (NORPACT-1): a multicentre, randomised, phase 2 trial [J]. Lancet Gastroenterol Hepatol, 2024, 9(3): 205-217.
36. Janssen QP, van Dam JL, van Bekkum ML, et al. Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial [J]. Lancet Oncol, 2025, 26(10): 1346-1356.
37. Garajová I, Peroni M, Gelsomino F, et al. A simple overview of pancreatic cancer treatment for clinical oncologists [J]. Curr Oncol, 2023, 30(11): 9587-9601.
38. Dekker EN, van Dam JL, Janssen QP, et al. Improved clinical staging system for localized pancreatic cancer using the ABC factors: a TAPS consortium study [J]. J Clin Oncol, 2024, 42(12): 1357-1367.
39. Pinson J, Henriques J, Beaussire L, et al. New biomarkers to define a biological borderline situation for pancreatic adenocarcinoma: results of an ancillary study of the PANACHE01-PRODIGE48 trial [J]. Ann Surg, 2024, 280(5): 734-744.
40. Stoop TF, Sugawara T, Oba A, et al. Adjuvant chemotherapy after resection of localized pancreatic adenocarcinoma following preoperative FOLFIRINOX [J]. JAMA Oncol, 2025, 11(3): 276-287.
41. Reni M, Macchini M, Orsi G, et al. Preoperative mFOLFIRINOX versus PAXG for stage Ⅰ–Ⅲ resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2×2 factorial phase 3 trial [J]. Lancet, 2026, 406(10522): 2945-2956.
42. Wainberg ZA, Link JM, Premji A, et al. Neoadjuvant modified FOLFIRINOX plus nivolumab in borderline-resectable pancreatic ductal adenocarcinoma: a pilot phase 1 trial [J/OL]. Nat Commun, 2026, 17: 2232. doi: 10.1038/s41467-026-68976-2.
43. Katz MHG, Petroni GR, Bauer T, et al. Multicenter randomized controlled trial of neoadjuvant chemoradiotherapy alone or in combination with pembrolizumab in patients with resectable or borderline resectable pancreatic adenocarcinoma [J/OL]. J Immunother Cancer, 2023, 11: e007586. doi: 10.1136/jitc-2023-007586.
44. Agarwal P, Guo M, Munjal K, et al. A phase Ⅱ study of neoadjuvant GVAX and cyclophosphamide combined with nivolumab and SBRT followed by surgery in borderline resectable pancreatic adenocarcinoma [J]. Clin Cancer Res, 2025, 31(15): 3205-3214.
45. Zheng L, Minasyan A, Davelaar J, et al. Preliminary translational immune and stromal correlates in a randomized phase Ⅱ trial of pembrolizumab with or without defactinib for resectable pancreatic ductal adenocarcinoma (PDAC) [J/OL]. J Clin Oncol, 2023, 41(16_suppl): 4024. doi: 10.1200/JCO.2023.41.16_suppl.4024.
46. Grierson PM, Wolf C, Suresh R, et al. Neoadjuvant BMS-813160, nivolumab, gemcitabine, and nab-paclitaxel for patients with pancreatic cancer [J]. Clin Cancer Res, 2025, 31(17): 3644-3651.
47. Wang WQ, Xu ZH, He TC, et al. Supervising the recurrence of pancreatic ductal adenocarcinoma using ctDNA-based MIR129-2 methylation detection [J]. Int J Surg, 2026, 112(1): 433-442.
48. Botta GP, Abdelrahim M, Drengler RL, et al. Association of personalized and tumor-informed ctDNA with patient survival outcomes in pancreatic adenocarcinoma [J]. Oncologist, 2024, 29(10): 859-869.
49. Guo MZ, Sachidanand AS, Nguyen T, et al. Postsurgical circulating tumor DNA as a prognostic biomarker for relapse of resected pancreatic ductal adenocarcinoma [J/OL]. J Gastrointest Surg, 2026, 30(4): 102359. doi: 10.1016/j.gassur.2026.102359.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress on neoadjuvant, adjuvant, and perioperative comprehensive treatment strategies for resectable pancreatic ductal adenocarcinoma

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